PETCO2监测在老年人胸段硬膜外麻醉中的应用

目的研究老年人胸段硬膜外麻醉对Sp02和PETCO2的影响。方法对48例老年人上腹部手术胸段硬膜外麻醉阻滞过程中Sp02和PETCO2进行观察。结果硬膜外注药后SpO2整个过程各时相与对照值均无显著变化。PETCO2在硬膜外注药30min后明显升高，同时动态观察到12例在静推芬氟合剂后PETCO2升高明显，峰相延长；4例肥胖患者舌后坠明显，PETCO2有一过性消失；6例患者在30min后，PETCO2峰相逐渐低慢，甚至消失，呼吸抑制明显。结论在老年人胸段硬膜外麻醉中监测PETCO2可及时了解呼吸状态，提高麻醉安全性。     

Masquerading Bundle-Branch Block—Electrophysiological Correlation

The term masquerading bundle-branch block has been used to describe a peculiar electrocardiographic abnormality in which the standard leads exhibit a left bundle-branch block pattern while the precordial leads manifest a right bundle-branch configuration. Autopsy studies of patients who have had this electrocardiographic pattern in life have shown diffuse conduction system disease, but direct recordings of conduction system function have never been reported. We recently cared for a man with masquerading bundle-branch block, and in this report we summarize the results of invasive electrophysiological testing. Our findings confirm that masquerading bundle-branch block can be associated with severe and diffuse conduction system disease, and that patients with this finding may require permanent pacemaker implantation, especially if they are symptomatic.     

Complete Atrioventricular Block after Arsenic Trioxide Treatment in an Acute Promyelocytic Leukemic Patient

A V block after arsenic trioxide (As₂O₃) treatment for refractory acute promyelocytic leukemia is very rare. In this patient, the block was at A-H level and manifested with complete AV block and Wenckebach second-degree type 3:2 block. The junctional recovery time during complete AV block did not significantly prolong after administration of more arsenic trioxide. The effect of heart block of arsenic trioxide seemed reversible after the discontinuation of arsenic trioxide and was not correlated to the leukemic status as observed in this patient.     

不同镇痛方法对胆囊切除术病人糖代谢和康复的影响

目的　观察比较多途径和单一方式镇痛方法对胆囊切除手术病人糖代谢和术后康复的影响。方法　 40例择期在硬膜外阻滞下行胆囊切除术的病人 ,随机分为多途径组 1(M1)、多途径组 2 (M2 )、对照组 1(C1)和对照组 2 (C2 )。C1组于术前从硬膜外腔给予吗啡 1mg +新斯的明 1mg。C2 组术后仅肌注哌替啶镇痛。M1和M2 组在C1基础上于术前至术后 2天口服双氯芬酸 ,M2 组于术毕在切口处采用 0 5 %布比卡因喷洒。结果　M1和M2 组血糖 (Glu)变化平稳。C1组血糖于术后第 1天上升 (P <0 0 5 ) ,C2 组血糖值则从术中至术后第 3天均明显上升 (P <0 0 5或P <0 0 1)。术后第 1天 ,四组胰岛素 (Ins)水平均明显上升 (P <0 0 5或P <0 0 1)。C1和C2 组胰岛素上升幅度明显高于M1和M2 组 (P <0 0 5 )。至术后第 3天 ,M1和M2 组胰岛素水平均恢复至正常水平 (P >0 0 5 ) ,而C1和C2 组胰岛素值仍高于麻醉前值 (P <0 0 5或P <0 0 1)。血浆皮质醇 (Cor)浓度均于术中 6 0分钟时明显上升 (P <0 0 1) ,与M1和M2 组相比 ,升高幅度以C1和C2 组显著 (P <0 0 5 )。IL 6水平在各组未见显著性改变 (P >0 0 5 )。结论　多途径镇痛方法对术后糖代谢和康复的影响小于单一途径镇痛术     

CHLOROQUINE ABUSE AND HEART BLOCK IN AFRICANS

Twelve of 30 Africans with heart block gave a history of chronic chloroquine abuse. Eleven of these had evidence of chloroquine retinopathy whereas four of the 18 nonabusers had abnormal ophthalmologic findings, thought to be senile changes. The chronic chloroquine abusers were all male and were younger (mean age 51.6 years) than the non-abusers (mean age 61.2), nine of whom were female. Serum chloroquine levels were not helpful diagnostically.
In the absence of other etiological factors, chronic chloroquine toxicity is important in the causation of heart block in Africans. (Aust NZ J Med 1989; 19: 17–21.)     

硬膜外血肿并天幕疝的CT研究

目的 分析硬膜外血肿并天幕疝的CT表现，探讨血肿体积与天幕疝程度的关系。资料与方法 对86例硬膜外血肿患者应用斜坡垂线扫描法进行研究。结果 斜坡垂线扫描图像上，36例显示天幕疝，其CT表现为：与颞叶脑组织相连的小脑幕内侧环池内软组织密度影。颞叶疝至幕下3mm以内者4例，3－6mm者12例，6mm以上者20例，相应血肿体积分别为30.99-34.81ml、32.84-41.76ml和39．15－69．54ml。结论 应用斜坡垂线扫描法，CT可对硬膜外血肿合并天幕疝作出准确诊断；血肿体积与疝入程度有关。     

41例心脏双束支阻滞围术期处理与文献回顾

目的 提高麻醉医生对手术患者心脏双束支传导阻滞的认识.方法 回顾我院近5年41例双束支传导阻滞患者围手术期处理情况,并复习双束支传导阻滞有关问题的研究进展.结果 40例双束支阻滞患者麻醉手术经过顺利,术中发生低血压和心动过缓时均对药物治疗有效;1例左前分支阻滞患者在二次手术麻醉时心电图证实发展为完全性左束支阻滞,最终抢救无效死亡.结论 术前无症状不伴有房室传导阻滞的慢性双束支阻滞患者不必常规安装临时起搏器,但准备适当的药物及临时起搏设备是必要的.     

Heart block following propofol in a child

We present the case of a nine-year-old boy afflicted with Ondine's curse, who developed complete atrioventricular heart block after a single bolus of propofol for induction of anaesthesia for strabismus surgery. Ondine's curse, the other name for congenital central hypoventilation syndrome, is characterized by a generalized disorder of autonomic function. Propofol has no effect on the normal atrioventricular conduction system in humans but it reduces sympathetic activity and can highly potentiate other vagal stimulation factors. Heart block has been documented after propofol bolus use in adults but, to our knowledge, not in children. It would appear that propofol is not a good choice for anaesthesia in congenital central hypoventilation syndrome.     

Alternating Wenckebach phenomenon in the His-Purkinje system: a case report

This report describes a case of distal AV block with a 2/1 conductionin basal conditions. Atrial stimulation induced an alternatingWenckebach phenomenon (AWP), always distal to the His bundlespike, with 8/3 or 6/2 conduction at an atrial rate of 88/min,and 12/3, 8/2 or 9/2 conduction at 130/min. Models for theseconduction disturbances are presented, based on previous workon AW in the AV node. The clinical significance of the distalAWP is discussed.